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NPI Code Detail

MEDICARE: DR. CRYSTAL BANKS DANIELS MD

MEDICARE: DR. CRYSTAL BANKS DANIELS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician4301057725MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962400556
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRYSTAL BANKS DANIELS MD
Provider Business Mailing Address
First Line : 228 E LAKE ST
Second Line :
City : ADDISON
State : IL
Zip : 60101-2889
Country : US
Telephone Number : 630-835-1430
Fax Number : 630-835-1433
Provider Business Practice Location Address
First Line : 228 E LAKE ST
Second Line :
City : ADDISON
State : IL
Zip : 60101-2889
Country : US
Telephone Number : 630-835-1430
Fax Number : 630-835-1433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 02/18/2021

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